Finally, our government leaders have recognized that Hawai'i's healthcare crisis is getting worse and are doing something about it. It is critical for the "patient" that government leaders successfully implement legislation that can save the rest of Hawai'i's hospitals from a fate similar to Kahuku's, and help retain the physicians and specialists we need to protect access to quality care for people in Hawai'i.

In her recent State of the State address, Gov. Linda Lingle hit the nail squarely on the head when she said: "High costs and low reimbursements are driving hospitals out of business and physicians out of the practice of medicine. We must act now, or there might not be an emergency room physician or other medical specialist available when our loved ones need them most."

MONEY IS THE ROOT

At the root of our ills is the simple fact that it costs healthcare providers more to deliver patient care than they are paid for providing that care.

Reimbursements are generally inadequate from all payers, but particularly from government payers, specifically Medicare and Medicaid. Last year, Hawai'i hospitals spent $228 million more to care for patients covered under Medicare and Medicaid (known as QUEST in Hawai'i) than they received in payment for that care.

Providers are essentially having to themselves "pay" for the cost of providing care to the uninsured, underinsured and those covered under government-funded programs, a situation that has gone on for far too long and must be fixed. It's no wonder we're seeing more symptoms such as the state having to intervene to save Kahuku Hospital, the serious lack of on-call trauma and specialty care, particularly on the Neighbor Islands, and doctors leaving the state for better conditions elsewhere.

To protect Hawai'i's healthcare, it is important to support the governor, state legislators and congressional delegation on current legislative efforts to improve the health of Hawai'i's healthcare providers. Among the most promising legislative initiatives are a one-time federal DSH payment of $10 million and a number of state bills aimed at moving Medicaid/QUEST reimbursement levels up to at least the federal Medicare level.

FEDERAL MATCHING

With Hawai'i hospitals bleeding, we must not forfeit the $10 million in federal money Sens. Dan Akaka and Daniel Inouye have worked so hard to get Congress to appropriate. Hawai'i is eligible to receive federal matching dollars for payments to hospitals that serve a disproportionately high number of poor or uninsured patients. But because Medicaid/QUEST is a federal-state jointly funded program, Hawai'i can only collect the full $10 million if the state puts up its share with a match of $8 million.

Legislative health committee chairs Rep. Maile Shimabu-kuro and Sen. David Ige have introduced companion bills HB 104 and SB 1672 to help address the frozen reimbursement problem for certain hospital and physician services that have seen no adjustment for nearly a decade. If passed, this will help move Hawai'i's Medicaid reimbursement levels closer to the true cost of care.

State Rep. Josh Green and several others have introduced a reinvestment in healthcare with HB 223. If passed, this bill will allocate money raised from the general excise tax on health services into a special healthcare fund that could be used to help cover costs of needed services such as emergency on-call doctors, emergency transport services, trauma care, and services for rural areas.

Recognizing that Kahuku is just the tip of the iceberg, government leaders are more clearly seeing that other chronic symptoms, including trauma and specialist physician shortages, trouble keeping and recruiting doctors, and the looming threat of reduced services or possible hospital closures, all stem from inadequate payment to healthcare providers.

We applaud these kinds of legislative proposals that turn us toward the right direction. What's exciting this time is that we may actually take some real steps forward. Finally, government leaders are working together — across party lines, across state and federal levels, and across government, providers and community — to keep Hawai'i's residents and healthcare providers healthy.